Treatment of Mixed Otitis Externa Using Ceftazidime Powder and Topical Miconazole Versus Topical Miconazole Only

Abstract

Background: Otitis externa is an inflammatory in external auditory canal, with the presentation of otalgia, otorrhea, and pruritus. Bacteria and fungi are the most causative agents of the disease. Although several antifungal and antibacterial agents are usually used to treat it, combination therapy plays an important role in good treatment efficacy. Objectives: According to the problems associated with the treatment of mixed otitis externa, the current study aimed at evaluating the efficacy of ceftazidime powder and topical miconazole (as the case group) versus topical miconazole only (as the control group) to treat mixed otitis externa. Methods: Seventy-two patients with mixed otitis externa were divided into two groups; the case group was treated with ceftazidime powder and topical miconazole, and the control group was treated only with topical miconazole. Both groups were evaluated after two weeks. The diagnosis of mixed otitis externa was based on signs, symptoms, and the presence of bacterial and fungal elements in direct examination and culture. Results: Swelling, itching, and canal discharge were observed in 67.7%, 64.7%, and 90.3% of the patients, respectively in the case group, and 47.1%, 26.3% and 93.1% of the patients, respectively in the control group. Complete resolution of all clinical signs and symptoms occurred in 23 (67.6%) patients in the case group and 11 (28.9%) patients in the control group (P = 0.001). Staphylococcus epidermidis and Pseudomonas aeruginosa were the most common bacteria, and Aspergillus spp. and Candida spp. were the most common fungi identified in the cultures. Conclusions: According to the complete resolution of clinical signs, the application of ceftazidime powder and topical miconazole was better than topical miconazole to treat mixed otitis externa.

Role of Clotrimazole in Prevention of Recurrent Otomycosis

“…In another investigation, otomycosis relapse was reported as 48% [30], and another study reported 14.29% [39]. Apart from the few mentioned investigations, in most studies, otomycosis relapse has been reported as less than 9% (7.1-8.8%) [6,17,28,40]. Overall, comparison of these results suggests the reduction of the rate of relapse of otomycosis due to using clotrimazole drop in the present study.…”

“…In the treatment of otomycosis, usually first fungal elements are removed from the ear (by suction or washing) and then dried. e medications used given the type of fungus include clotrimazole or miconazole, which are used in combination with antibacterial drugs such as ceftazidime [12,27,28]. Nevertheless, some compounds with disinfection properties such as betadine and boric acid in combination with miconazole have also been used [12,24].…”